California Medicaid MU overpayments reach $22M

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From October 2011 through December 2014, the California Department of Health Care Services made incorrect payments to hospitals participating in the Medicaid EHR incentive program, resulting in an overpayment of $22 million to 61 hospitals, reports HHS' Office of Inspector General.

In the reviewed time frame, the state paid nearly $600.1 million in Medicaid EHR incentive payments to eligible hospitals. The OIG further reviewed incentive payments of 64 hospitals in California and found errors in payment to 61 of them. Total payment errors — including both overpayments and underpayments — exceeded $23.2 million.

The OIG recommends the state refund the $22 million made in net overpayments to the 61 reviewed hospitals, adjust those hospitals' remaining incentive payments to mitigate incorrect calculations, review calculations for hospitals not reviewed by the OIG to ensure they are accurate and review documentation from all hospitals to identify any other errors in incentive payment calculations.

The state agreed with all the recommendations except the first one, which prompts the state to repay the federal government the net overpayment amount. The state agency said in comments it agrees that incorrect Medicaid EHR incentive payments may have been made, but it does not agree with the recommendation to refund the federal government the requested amount. "DCHS was advised by CMS that over/underpayments could be addressed through adjustments of future incentive payments to eligible hospitals," read the agency's comments. "In addition, DHCS believes further detailed analysis and validation of data reported by eligible hospitals is required in order to support overpayments identified by the OIG."

The OIG maintains its findings and recommendations.

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